By Alan Moses
HealthDay Reporter
MONDAY, April 24, 2023 (HealthDay News) — Sciatica can cause unrelenting, throbbing pain in the legs, and surgery is often recommended if less invasive measures fail to relieve it.
Unfortunately, a review of a new study suggests that such operations are likely to only provide temporary results, with pain usually returning within a year.
Sciatica is “characterized by pain down the back of the leg, most often due to pressure on a spinal nerve root caused by a ruptured spinal disc in the lower back,” the author said. of the study, Christine Lin, Professor of Sydney Musculoskeletal Health at the University of Sydney in Australia. “The condition can also manifest as back pain, muscle weakness and a tingling sensation in the lower leg.
“We set out to investigate whether surgery was effective in relieving pain and disability in people with sciatica caused by a ruptured [spinal] disc,” Lin said.
But after reviewing 24 previous studies, she and her colleagues concluded that while partial removal of a ruptured disc (discectomy) resulted in short-term pain relief and disability, “benefits diminished over time, and at one year there were no benefits of treatment. compared to people who did not have surgery.”
Lin noted that while surgery is not the only intervention for patients with sciatica, “we don’t have a lot of treatment options that are supported by scientific evidence.”
There is only “limited evidence” to suggest that an exercise program (physical therapy) is helpful. Similarly, Lin said, there is little evidence that drugs — including steroids injected directly into the lower back — are effective in providing substantial pain relief.
Many patients opt for surgery, Lin said, despite the risk of disc tearing and wound complications.
To assess the relative effectiveness of surgery, Lin’s team reviewed two dozen studies that had previously compared the potential benefits of surgery with non-surgical options for sciatica patients whose condition was caused by a herniated disc.
Half of the studies specifically examined surgical outcomes after a discectomy procedure. Non-surgical options included steroid injections and/or sham surgery or sham treatments.
The studies variously tracked pain relief outcomes for periods of up to one year after treatment.
In the end, Lin and his colleagues determined that the evidence that discectomy surgery was more effective in reducing leg pain than non-surgical options was “very low” to “low.”
The team further noted that existing evidence suggested that surgery was better than non-surgical options when it comes to providing “moderate” pain relief within three months of surgery.
But after three months, and up to a year later, the ability of surgery to provide better pain relief than non-surgical options was found to be relatively “small.” And no significant benefit in pain relief was seen a full year after surgery.
The team acknowledged that the studies under review were conducted under different conditions, which could affect the criteria by which patients were considered eligible for surgery. In addition, study discussions of non-surgical outcomes were often found to be of poor quality.
Lin said the result of the review, published on April 19 in the bmj, “It wasn’t entirely surprising, as previous research had similar findings.”
Still, he stressed that most people with sciatica get better over time, so for many patients the short-term relief that surgery can provide “might still be worth it,” if patients and surgeons decide to pursue that approach. path.
Could some patients earn more from surgery than others? Lin said that at the moment, “we don’t have enough information” to know.
But their conclusion is that “surgery could be considered as an early treatment option, which may be important for those patients for whom rapid pain relief may be a priority and who think the short-term benefits of surgery outweigh the potential risks and costs. of surgery.”
Annina Schmid, co-author of an editorial published with the review, is director of the Neuromusculoskeletal Health and Science Laboratory at the Nuffield Department of Clinical Neurosciences at the University of Oxford, England.
She seconded the observation that the majority of sciatica patients, about 7 out of 10, “recover on their own,” regardless of whether they opt for physical therapy, medication or surgery.
“So what this study shows is that, in the long term, both surgery and conservative care provide comparable symptom relief,” Schmid said.
More information
The Cleveland Clinic has more about sciatica.
SOURCES: Christine Lin, PhD, professor, Sydney Musculoskeletal Health, School of Medicine and Health, University of Sydney, NSW, Australia; Annina Schmid, PhD, associate professor and head of the neuromusculoskeletal health and science laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; bmj, April 19, 2023, online
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